Foot Pain & Crohn's Disease
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Understanding the connection between IBD, foot pain & treatment strategies
Foot & ankle pain can arise independently or as a complication of inflammatory bowel disease.
Crohn’s disease is a type of inflammatory bowel disease. People with Crohn’s disease experience chronic inflammation in the gastrointestinal tract.
Symptoms vary in individuals, but the most common symptoms of Crohn’s include abdominal cramping and pain, constipation, diarrhea, loss of appetite, fatigue and more.
Because Crohn’s is a chronic condition, patients can experience flare-ups and periods of remission when symptoms subside.
How does Crohn’s cause foot pain?
Inflammatory bowel diseases such as Crohn’s are immune-mediated, meaning the body’s own immune system mistakes gut bacteria for a threat and causes inflammation when attacking the ‘invaders’.
This type of chronic immune response can lead to inflammation and pain outside the digestive tract as well.
Crohn’s disease and arthritis pain
Arthritis is the number one most common IBD complication outside the intestines. Up to 25% of people suffering Crohn’s disease or ulcerative colitis (another type of IBD) may be affected by inflammation, swelling, and stiffness of the joints.
There are two main types of arthritis associated with IBD:
- Peripheral arthritis (arthritis in joints not including the spine)
- Axial arthritis (arthritis of the lower spine – aka spondyloarthropathy/spondylitis)
A rare, severe form of spondylitis called ankylosing spondylitis (AS) can cause inflammation in the heart valves, lungs and eyes in addition to the spine. Only about 2-3% of IBD sufferers develop AS as a complication.
Peripheral arthritis is more common in patients with Crohn’s disease or other type of inflammatory bowel disorder. In fact the amount of inflammation in the arthritic joints tends to mirror the amount of inflammation in the colon as intestinal symptoms worsen and improve.
Research suggests chronic inflammation of the intestines can trigger inflammation in joints. Crohn’s disease and rheumatoid arthritis are both classified as immune-mediated inflammatory diseases and can share common inflammatory pathways.
Peripheral arthritis can affect joints in the ankles and feet (and knees, hips, shoulders, etc) causing joint pain, fluid retention and decreased flexibility.
Typically, IBD-related peripheral arthritis is not as severe as rheumatoid arthritis, and does not usually cause lasting damage.
Crohn’s and Plantar Fasciitis
To understand how Crohn’s disease relates to plantar fasciitis, start with the entheses. Entheses are connective tissues at the site where a tendon or ligament connects with bone.
Stress and inflammatory diseases can cause inflammation, fibrosis or calcification of the entheses, leading to pain and dysfunction.
Plantar fascia is the thick tissue on the bottom of your foot, connecting the heel bone to the toes. Inflammation of the plantar fascia causes pain and aching in the heel and arch of the foot.
Achilles Tendonitis and Crohn’s Disease
The entheses (where tendons connect to bone) can become inflamed and painful as a result of Crohn's disease.
Achilles tendonitis is the most common type of enthesitis (inflammation of the entheses, the site where tendons and ligaments connect to bone).
The Achilles tendon connects the base of your calf muscles to your heel bone at the back of the leg. Symptoms of Achilles tendonitis include heel pain, tenderness and stiffness at the back of the heel.
Achilles tendinitis is usually caused by injury or repetitive strain, especially as we get older. Crohn’s disease can also cause tendonitis, and in some cases it may be the first symptom indicating the presence of inflammation in the bowels.
Because Achilles tendonitis can make the tendon weaker and more likely to rupture, it’s important to understand what’s causing the tendonitis pain before treating the symptoms.
Why you need an expert diagnosis of your foot and ankle pain
Many patients diagnosed with Crohn’s or other type of inflammatory bowel disorder have painful feet or ankles but fail to mention joint pain to their gastroenterologist. They may never realize their foot pain is related to inflammation in the colon, or simply chalk it up to getting older.
It’s also possible your foot and ankle pain is not a complication of your Crohn’s disease. Side effects of certain medications can cause joint pain. Long-term use of steroids like prednisone can lead to bone loss and joint pain.
It’s imperative to know if foot, heel and ankle pain has an independent underlying cause, or is related to IBD or another type of disease. Treatment strategies can be very different depending on the official diagnosis.
Treating foot, ankle & heel pain caused by Crohn’s disease
The first step is getting an accurate diagnosis of Crohn’s disease, and an accurate diagnosis of any pain or discomfort in the feet and ankles.
When foot pain is related to bowel inflammation, getting effective treatment for the underlying cause is very important. As symptoms of Crohn’s disease are treated and improve, joint and tendon pain in the ankles and heels should improve with it.
Other treatment options can include over the counter or prescription medicine for pain, though some people with Crohn’s disease can’t tolerate painkillers because they irritate the digestive tract and increase inflammation. Corticosteriods can pull double-duty and treat symptoms of both IBD and joint pain in some patients.
Physical therapy and at-home exercises and stretching can also be part of an effective treatment plan for Crohn’s disease foot pain.
Diagnosing & treating all types of foot, ankle & heel pain in Milwaukee
No matter what type of foot pain you’re experiencing or how long it’s been bothering you, our surgical podiatrists will get to the true cause and develop an effective, personalized treatment strategy.
With five podiatry clinics in the Milwaukee area and relationships with many area hospitals, Advanced Foot & Ankle of Wisconsin makes it easy to connect with a caring and experienced foot doctor so you can find relief.